Australia's Leading Ophthalmic Magazine Since 1975

Australia's Leading Ophthalmic Magazine Since 1975

RANZCO CEO responds

31/10/2018

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Australia’s first Indigenous ophthalmologist, Dr Kristopher Rallah-Baker, contributed an Opinion column in September titled 'Closing the gap from both sides' commenting on racism and a lack of Indigenous representation within the profession. RANZCO CEO DR DAVID ANDREWS has submitted the following letter to the editor in response.

Dear Editor,

RANZCO Fellows have a proud tradition of caring for Indigenous Australians, starting with early pioneers such as Professor Ida Mann and luminaries like Fred Hollows and Hugh Taylor.

While there is certainly still a lot do with respect to Indigenous eyecare in Australia, it is in fact very well served by RANZCO Fellows and outcomes are consistently improving. Closing the Gap in Eye Health has been one of RANZCO’s top priorities.

We have developed a multifaceted policy to improve the quality and sustainability of care of Indigenous communities, recognising that excellent eye health service needs more than an improvement in cultural safety.

It requires coordination of care across the community, primary care, visiting services and hospitals. It requires active community engagement. It requires appropriate, targeted funding from government. RANZCO, together with Vision 2020, NACCHO, Optometry Australia and the Indigenous Eye Health Unit at Melbourne University, has developed detailed and coherent plans to improve eye health outcomes.

In terms of cultural awareness, we have a number of initiatives in place or being introduced. For example, we are currently developing a Reconciliation Action Plan (RAP) with the help of Reconciliation Australia. We have recently worked with Professor Angus Turner and aboriginal patients to develop cultural safety modules available to all trainees and Fellows. We have revised our training post standards to ensure all hospitals provide appropriate cultural safety training to our trainees.

While it is true that more Indigenous ophthalmologists would be a positive step, it is not true that only Indigenous ophthalmologists can be dedicated to, and culturally sensitive in, providing excellent eye health services and promotions for Indigenous people. This is evident in the pioneers of Indigenous eyecare in Australia such as Fred Hollows, Ida Mann, Hugh Taylor, Bill Glasson, Mark Loane, Richard Rawson and Minas Coroneo, all non-Indigenous.

More recently there are a great many RANZCO Fellows that have provided or do provide extensive training to junior doctors and service to Indigenous patients. Tim Henderson, Nitin Verma, Richard Mills, Shane Durkin, Stuart Lake, Angus Turner, Stephen Godfrey, Rowan Porter, Tharmalingam Mahendrarajah, Ashish Agar, Michael Lane, Gary Brian, Bill Talbot, Gayatri Banerjee and Michael Hennessey, are but a few of the ophthalmologists providing culturally sensitive care to Indigenous communities and training to our future workforce.

RANZCO is also focused on facilitating more Indigenous ophthalmologists in the future, but the training places are largely controlled by state health department budgets. In any one year the number of available places will vary but it is usually 28–30 in Australia. RANZCO receives applications from around 120–140 highly qualified young doctors, from a wide variety of cultural backgrounds, all desperate to be selected.

We can only provide places on the program that match the number of positions funded, and the state health departments have the final say in the selection. That said, through the direct support of many RANZCO Fellows and our own scholarships to Indigenous medical students and junior doctors we are strongly encouraging a number of young Indigenous doctors to obtain the necessary experience that will see them well placed to be selected in future. We are also revising the selection process to ensure suitably qualified Indigenous doctors are guaranteed an interview for selection.

For any RANZCO Fellows who wish to work with the college to further this agenda, there are excellent opportunities to do so. For example, RANZCO has an Aboriginal and Torres Strait Islander Committee, which is tasked with promoting cultural awareness and strategies to overcome cultural barriers in the provision of quality eyecare to Indigenous populations in urban, regional and remote areas.

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The committee also has a role in providing advice on the policies around selection and training, for example, and how they can best support getting more Indigenous doctors into ophthalmology. Dr Rallah-Baker has previously been invited to join this committee and help improve the system. That invitation remains open should he decide to join in the future.

At a college level we do not tolerate the behaviours implied by Dr Rallah-Baker in his article. If there are specific examples of such behaviours, the college has processes in place to address them. We are actively engaging in the promotion of inclusiveness and tolerance for all within the college and have a robust complaints process to deal with bullying and discrimination.

We are working with the Council of Presidents of Medical Colleges, Australian Indigenous Doctors Association (AIDA) and NACCHO to ensure the whole medical workforce understands and provides culturally appropriate care. That said, while we aim to do all that we can, the ability of RANZCO to influence a system wide culturally safe environment is limited by our size and remit within the health system.

It is worth noting that the RANZCO ophthalmology training program is difficult, demanding and requires a very high level of skill and dedication to complete. The public should and do expect consultant ophthalmologists to be trained to the highest standard. Many people from different walks of life have found Fellowship training challenging but, with persistence and application, ultimately rewarding. This always has been the case, and because of the standards required, will continue to be so, meaning that all trainees will always be critically evaluated.

With all that in mind, we do, of course, want all RANZCO trainees to succeed. RANZCO provides additional support and assistance to any trainee who is having difficulty completing the program. Dr Rallah-Baker, like other trainees, was the beneficiary of a great deal of assistance from RANZCO and the many Fellows that helped him successfully complete the training program. We are continually seeking to improve the training and support available to all trainees and we look forward to the opportunity to support and train other Indigenous candidates through training program.

As a Fellow of RANZCO and the next president of AIDA, I hope Dr Rallah-Baker will be involved in a positive way in encouraging young doctors to apply to RANZCO and in supporting the continuing improvement of the training program. Reforming the system comes by working together with the many staff and Fellows who are passionate about improving outcomes in Indigenous eyecare.

Original article: Closing the gap from both sides

The dire state of Indigenous eye health is one of the most well documented, yet enduring features of Australian eyecare. There are countless reasons for this and improvements can be made in a whole host of areas.

However, an area that is rarely discussed is the relative lack of Indigenous eyecare professionals comparative to the rest of the population, especially ophthalmologists. Out of more than 1,000 ophthalmologists in Australia there is just one Indigenous ophthalmologist – me.